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Physicians are typically trained to document patient care and bill for procedures, not to pay attention to details required for proper diagnosis coding. On average, we find over 20% of retrieved charts for Medicare Advantage risk adjustment retrospective review contain a document gap. Closing these gaps means better coverage of disease burden and increased revenue capture. Apixio’s HCC Doc Gaps solution helps you find these gaps quickly so you can increase your risk capture.

Missing documentation is reducing your risk score

Physicians who treat MA patients often fail to add all elements required for risk adjustment. They are good at procedure coding given fee-for-service billing, but not diagnosis coding. An element missing from a document for risk adjustment could be as simple as a physician signature. The difference between capturing the disease for a risk score and ignoring it can mean a missed care management opportunity and lost revenue. These gaps are common and can happen for a variety of reasons:

  • Documents are not signed by a physician
  • Unclear date of service
  • Assessment does not include a treatment plan

Whatever the cause, our HCC Doc Gaps solution identifies remedies that, if acted upon by physicians, can deliver better patient care and higher reimbursement.

Fast Facts

0 %
Charts with clinical documentation gaps
0 %
Medicare payments lacking sufficient documentation
$ 0 Billion
Annual value of submitted claims without proper justification

Find gaps for rapid closure

Powered by Apixio’s patented machine learning platform, our HCC Doc Gaps solution allows your organization to analyze member charts and identify encounter notes with attributed HCCs lacking critical documentation elements required for CMS submission. The identified document gaps are then presented to coders in our intuitive web-based application for rapid review and agreement. Each gap notification is attributed to a provider and includes the critical missing elements and the encounter date of service. The gaps are then ranked by value, if closed, and by the attributed providers predicted to take action.

With HCC Doc Gaps, your organization can:

  • Implement a high-yield retrospective program based upon definitive diagnoses
  • Educate and train physicians to improve their documentation using specific examples
  • Improve capture of disease in charts for risk adjustment
Testimonial

By using Apixio, we’re improving our auditing bandwidth and enhancing the ability of our coders to focus on other chart audits and other projects that we couldn’t do before.

JoAnn Hayden
Scripps Health Plan Services
Testimonial

We’ve previously relied on tedious manual review of our charts that required lots of manpower and physician time...the HCC Profiler has allowed us to mine our EHR and scanned chart data for valid, risk-adjusting conditions with incredible transparency and efficiency.

Jennifer Pereur
Directory, Government Programs
Testimonial

The coding team was wonderful to work with, and incorporated our specific coding guidelines when working on our project. When they noticed a trend in what we were rejecting, they shared a Coding Clinic we were unaware of for clarification on how to code the scenarios.

Josh Weisbrod
VP of Risk Adjustment
Case Study

Apixio & Magna Health Plan

Fast Facts 40,633 lives reviewed 2,755 HCC deletes found 95.3% agreement with…

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Case Study

How a Veteran Coder Used Apixio’s HCC Profiler to Eliminate Data Entry Error and Double Productivity

Fun Stats Increased productivity from 3 charts per hour to 10 charts…

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Case Study

Sigma Health Plan

Fast Facts 70,000 lives reviewed 983 new HCC codes 98.5% coding accuracy…

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Improve your diagnosis capture with Apixio’s HCC Doc Gaps solution